Provider Demographics
NPI:1205328648
Name:BARTEL, KYLENE (RDH)
Entity type:Individual
Prefix:
First Name:KYLENE
Middle Name:
Last Name:BARTEL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:KYLENE
Other - Middle Name:
Other - Last Name:PATRIZI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 SHENANGO AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-1503
Mailing Address - Country:US
Mailing Address - Phone:724-734-2175
Mailing Address - Fax:724-342-6609
Practice Address - Street 1:2807 WILMINGTON RD
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16105-1263
Practice Address - Country:US
Practice Address - Phone:724-656-3486
Practice Address - Fax:724-598-7337
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-01
Last Update Date:2019-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH070206124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA103499736Medicaid
PA1034997360003Medicaid
PA1034997360001Medicaid
PA1034997360002Medicaid